Field Reimbursement Manager, Immunology (Eastern US)

Sobi•Boston, MA

5h•$115,000 - $150,000•Onsite

About The Position

Sobi is seeking a highly experienced, passionate Field Reimbursement Manager. Reporting to the Director of Field Reimbursement in the Immunology Franchise, the Field Reimbursement Manager (FRM) is an important member of the Sobi Market Access team. The FRM role is a field-based, non-promotional resource for infusion centers, health systems, institutions, hospitals, and HCP practices/groups that serves as the key to help unlock patient access and resolve reimbursement issues. The successful candidate brings strong knowledge and proven work history of access and reimbursement for buy-and-bill/infused pharmaceutical products. The FRM, in addition to working closely with external customers, will work with numerous internal teams, including Patient Services, Market Access colleagues, Medical Affairs, Advocacy, and Marketing to facilitate and support patient access to treatment. The FRM is a critical component of customer support and will rely on strong problem-solving skills to provide outstanding customer experiences and outcomes. The successful candidate will accomplish this by: Customer Engagement: As a field reimbursement manager, the FRM is expected to maintain a targeted account list of customers and proactively engage accounts live and virtually. Proactively and consistently working with assigned customers to educate on access and reimbursement as well as build and maintain relationships with all relevant departments and personnel, including but not limited to Infusion Center Manager, Biologic Coordinators, Reimbursement Specialist/Coordinator, Patient Access Specialist, Financial Counselors, Billing and Coding Specialists, Nurse Navigator, Pharmacists, Revenue Cycle Manager, Patient Advocates and prior authorization specialists. Acting as the subject matter expert with a deep level of understanding of buy and bill reimbursement and access & reimbursement across all channels (Commercial, Medicare, Medicaid, Government) who educates and identifies compliant solutions to overcome patient access and reimbursement issues. Providing proactive education to prescribers and sites of care upon patient enrollment on coverage for Sobi therapies, common prior authorization requirements, and coding and billings requirements. Providing comprehensive education to healthcare providers and their staff on reimbursement procedures, coding, billing, and documentation practices specific to biologic therapies. Educating infusion centers, HCP offices, health systems, institutions, and hospitals, in understanding the mechanics of patient benefit verification, product ordering through Specialty Pharmacy, Specialty Distribution. Demonstrated ability to investigate access challenges pre and post-infusion for Sobi products Assist healthcare providers in understanding and managing reimbursement processes for buy-and-bill infused biologic products. This includes offering compliant support on prior authorizations, appeals, and denials. Assisting infusion centers, HCP offices, health systems, institutions, and hospitals, in understanding billing & coding; specifically, CPT coding, J-Codes and modifiers as well as use of CMS 1500 and UB-04 forms. Acting as a bridge between the customer, the patient services team, and Sobi sales and account management team to address access escalations and payer access issues. Working closely with the HUB and the Case Managers to compliantly address escalations and access issues for HUB patients. Working with local Sobi colleagues with a high level of cross-functional support for accounts in a defined geography. Additional responsibilities include developing local solutions through account and market insight and providing Sobi leadership with market intelligence. This role inspires solution-oriented passion across cross-functional teams.

Requirements

Demonstrates deep knowledge in: Reimbursement experience supporting infused product – Buy and Bill
Reimbursement and access across all channels (Commercial, Medicare, Medicaid, Exchange and Government) and is the subject matter expert of the payers in the markets they will support
All phases of specialty distribution, specialty pharmacy core services to assist with supporting access and product procurement
Healthcare structures, payment systems, and reimbursement methodology
Works compliantly and collaboratively with internal and external business partners to win—Thinks and acts as a team; understands the nature and interdependencies of a matrix team environment and can effectively work cross-functionally to seize opportunities, resolve payer issues, improve customer experience, avoid bureaucracy, and maximize outcomes of strategies and key actions.
Internal Partners: Sales, Marketing, Patient Services (case managers, nurse support), Trade Team, National and Regional Account Directors, Medical Affairs
External Partners: Builds relationships with: Infusion Centers, Health Systems, Institutions, Hospitals, HCPs, practice managers, reimbursement/access departments, and other customers who support access & reimbursement
Exhibits strong problem-solving skills related to complex patient access challenges across payers and specialty pharmacies
Ability to educates health systems, institutions, hospitals, and HCP office staff about: Patient Service Program options to optimize patient access to Sobi’s products
Prior authorization requirements, coverage status, and payer appeals requirements, processes, and timelines
Billing and Coding
Comprehends and effectively demonstrates ability to compliantly conduct field-based customer support related to payer coverage and payment process (coverage navigation & specialty pharmacy fulfilment)
Adheres to all relevant pharmaceutical industry regulations (including but not limited to FDA rules and PhRMA Code) and Sobi Ethics & Compliance policies, and demonstrates a willingness to coach to ensure a culture of compliance
A minimum of a B.A/B.S. required
A minimum five (5) years of reimbursement work experience in Pharmaceuticals/Biotech/Medical Device with relevant understanding of the following areas: Patient journey navigation
Payer coverage polices
Medical & Pharmacy benefit reimbursement
Specialty pharmacy and distribution
In office dispensing accounts
Hub and Patient Services
Industry Knowledge – proficient understanding of the pharmaceutical industry, disease state and drug distribution process (e.g., medical, specialty pharmacy, managed care systems, etc.)
Understanding of Commercial, Medicare and Medicaid drug coverage and current and pending changes to drug coverage benefits
Technical Expertise (Reimbursement and Patient Access) in the buy and bill space: Reimbursement and patient access knowledge with the ability to effectively convey knowledge to key stakeholders.
Skills and Competencies: Computer Skills – Ability to effectively use technology to support escalation work internal and external portals and databases
Advanced Microsoft Excel skills that support analysis of large databases and manage a high volume of data
Analytical Skills – Ability to analyze and leverage data/reports to identify trends and opportunities
Demonstrates Passion, high energy, excitement, and a sense of urgency toward organizational purpose and values.
Cultivates High IMPACT Partnerships with internal and external partners—Develops meaningful partnerships based on Sobi Core Values striving to earn and preserve the trust, respect, and admiration of all stakeholders.
Values & Unlocks Collaboration—Cultivates an atmosphere of collaboration and reciprocal communication that creates an environment that inspires all to demand the ‘best’ from themselves
Business Savvy—Demonstrates a clear understanding of the current territory business situation, marketplace, and environment.
Understanding and application of HIPAA rules and regulations related to patient privacy
Strong written and verbal communications as well as presentation skills
Estimated travel 50%

Nice To Haves

Preference will be given to candidates with the following experience: Buy and Bill and infusion reimbursement experience
Launch reimbursement experience
Strong understanding of the Gout disease state and treatment options
Demonstrated ability to work targeted accounts; specifically working to identify, engage and build relationships with key reimbursement contacts, access personnel and practice managers within identified accounts.

Responsibilities

Customer Engagement: As a field reimbursement manager, the FRM is expected to maintain a targeted account list of customers and proactively engage accounts live and virtually.
Proactively and consistently working with assigned customers to educate on access and reimbursement as well as build and maintain relationships with all relevant departments and personnel, including but not limited to Infusion Center Manager, Biologic Coordinators, Reimbursement Specialist/Coordinator, Patient Access Specialist, Financial Counselors, Billing and Coding Specialists, Nurse Navigator, Pharmacists, Revenue Cycle Manager, Patient Advocates and prior authorization specialists.
Acting as the subject matter expert with a deep level of understanding of buy and bill reimbursement and access & reimbursement across all channels (Commercial, Medicare, Medicaid, Government) who educates and identifies compliant solutions to overcome patient access and reimbursement issues.
Providing proactive education to prescribers and sites of care upon patient enrollment on coverage for Sobi therapies, common prior authorization requirements, and coding and billings requirements.
Providing comprehensive education to healthcare providers and their staff on reimbursement procedures, coding, billing, and documentation practices specific to biologic therapies.
Educating infusion centers, HCP offices, health systems, institutions, and hospitals, in understanding the mechanics of patient benefit verification, product ordering through Specialty Pharmacy, Specialty Distribution.
Demonstrated ability to investigate access challenges pre and post-infusion for Sobi products
Assist healthcare providers in understanding and managing reimbursement processes for buy-and-bill infused biologic products. This includes offering compliant support on prior authorizations, appeals, and denials.
Assisting infusion centers, HCP offices, health systems, institutions, and hospitals, in understanding billing & coding; specifically, CPT coding, J-Codes and modifiers as well as use of CMS 1500 and UB-04 forms.
Acting as a bridge between the customer, the patient services team, and Sobi sales and account management team to address access escalations and payer access issues.
Working closely with the HUB and the Case Managers to compliantly address escalations and access issues for HUB patients.
Working with local Sobi colleagues with a high level of cross-functional support for accounts in a defined geography.
Additional responsibilities include developing local solutions through account and market insight and providing Sobi leadership with market intelligence. This role inspires solution-oriented passion across cross-functional teams.

Benefits

Competitive compensation for your work
Generous time off policy
Opportunity to broaden your horizons by attending popular conferences
Emphasis on work/life balance
Collaborative and team-oriented environment
Making a positive impact to help ultra-rare disease patients who are in need of life saving treatments
Competitive compensation for your work
Generous time off policy
Opportunity to broaden your horizons by attending popular conferences
Emphasis on work/life balance
Collaborative and team-oriented environment
Making a positive impact to help ultra-rare disease patients who are in need of life saving treatments
A competitive 401(k) match to support your financial future.
Tuition and wellness reimbursements to invest in your personal and professional growth.
A comprehensive medical, dental, and vision package to prioritize your health and well-being.
Additional recognition awards to celebrate your achievements.